Enterococcus faecalis causing delayed spondylodiscitis in a case with retained intraspinal bullet.

Delayed presentations have been reported following gunshot wounds (GSW) with retained intraspinal bullets due to migration of projectile or lead intoxication. We report on the rare occurrence of delayed pyogenic spondylodiscitis and neurological dysfunction following injury from low velocity GSW to the spine with a retained projectile. A 55-year-old male presented 4 months following GSW to the abdomen which resulted in colonic injury and L5 fracture. The patient was treated initially with ileo-transverse anastomosis, antibiotics, without retrieval of the bullet. He developed low back pain, claudication 4 months following GSW and investigations suggested a pyogenic spondylodiscitis at L5-S1. The patient was treated with surgical debridement of infective focus and stabilisation with definitive fusion being performed after an interval of 14 days. The biopsy of the lesion confirmed findings of spondylodiscitis and the culture isolated Enterococcus faecalis species. The patient was treated with antibiotics as per sensitivity and made an uneventful recovery over 4 weeks. The follow-up radiographs showed satisfactory healing at final follow up of 24 months. GSW with colonic perforation have higher incidence of infective complications however majority to these occur in the early postoperative period. This case report demonstrates the possibility of late onset presentation due to spinal infection occurring following colonic perforation with retained intraspinal bullet.